Pilonidal Sinus Surgery

• Pain, tenderness or swelling at the top of the buttock cleft
• One or more small pits or openings in the skin over the tailbone
• Discharge of pus, blood or fluid, sometimes foul-smelling
• A painful lump or abscess that may develop suddenly
• Redness and warmth of the skin in the area
• Visible hairs protruding from a pit or opening
• Recurrent flare-ups of infection in the same spot
• Feeling generally unwell or feverish during an acute infection

Pilonidal disease is thought to develop when loose hairs and skin debris collect in the natural cleft between the buttocks and become driven into the skin, where they trigger a foreign-body reaction and form a sinus. Friction and pressure from sitting, along with moisture and bacteria in the area, encourage infection and the formation of tunnels and pits.

Several factors raise the risk, including being male, being a young adult, having thick or coarse body hair, a deep buttock cleft, a sedentary or seated lifestyle, being overweight, and a family history of the condition. Poor local hygiene and excessive sweating can also contribute. Understanding these factors is helpful, because measures such as hair removal and good skin care play a part in preventing recurrence after treatment.

The diagnosis is usually straightforward and made by examining the skin over the lower spine and buttock cleft, where the characteristic pits, openings or a tender swelling can be seen. Mr Hussain assesses the extent of the disease, the number and position of any sinus openings, and whether infection is currently active, as this guides the choice and timing of treatment.

In most cases no scans are needed, but for extensive, recurrent or complex disease imaging such as an MRI may occasionally be used to map the tunnels before reconstructive surgery. If an abscess is present, it is generally treated first to control infection, with definitive surgery planned once the acute episode has settled.

At your consultation Mr Hussain examines the skin over the lower spine and buttock cleft to assess the pits, openings and any swelling, and judges how extensive the disease is. This guides which treatment suits you, from minimally invasive EPSiT through to a flap procedure such as the cleft-lift. If an abscess is present it is usually drained first to settle the infection, with definitive surgery planned once things have calmed down.

Surgery is carried out under anaesthetic, most often as a day case, so you go home the same day. Minimally invasive EPSiT involves no large wound and a quick recovery, while flap procedures use a closed wound placed off the midline to encourage healing. Mr Hussain gives clear advice on keeping the area clean, attending any dressing changes and — importantly — keeping the area free of hair to prevent the sinus returning.

Recovery varies considerably with the procedure performed. Minimally invasive EPSiT usually allows a quick return to everyday life, often within a few days to a couple of weeks. Flap procedures such as the cleft-lift, Karydakis or Limberg involve a closed wound and stitches, with most people back to desk-based work within two to four weeks, avoiding heavy exertion and prolonged sitting in the early stages. If a wound is left open to heal naturally, full healing can take several weeks of regular dressing changes.

Aftercare focuses on keeping the area clean and dry, attending for any dressing changes or stitch removal, and avoiding activities that put strain or friction on the wound until it is fully healed. Long-term, Mr Hussain strongly recommends keeping the area free of hair through regular shaving or hair-removal methods, along with good hygiene, as this is one of the most effective ways to prevent the sinus returning.